| NPI | 1801516984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 3156) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0021830) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2026-03-10 |